The best therapies for kids and teens educate everyone in the family about bipolar disorder, improve communication, decrease stress, and increase adherence to treatment.
By Adelaide Robb, MD
While medication is an important cornerstone of treatment, therapy is the other main support in care for youth with bp and their families. This can include supportive therapy that provides information for youth and parents about the disorder, treatments, and course of the illness, as well as individual, group, and family therapy.
What kinds of therapies work, according to research?
An excellent review of the field published in 2015 searched all of the clinical and research literature to see what evidence is known about effective therapies for pediatric bipolar disorder (PBD). Multifamily psycho-educational psychotherapy and family-focused therapy were the two most studied options with the best support for effectiveness. A third, child- and family-focused cognitive behavioral therapy, may be characterized as a treatment in its experimental phase, with studies of its effectiveness just being started. Other therapies did not have support for benefit in pediatric bipolar disorder.
What is multifamily psychoeducational psychotherapy?
This therapy consists of 8 sessions of 90 minutes each for parents and, separately, children with bipolar disorder. The goals of the sessions are to increase knowledge about PBD, including treatment options and adherence; to improve detection and management of symptoms leading to an episode; and to enhance the family unit’s sense of support in coping with PBD. In two randomized trials, parents learned more about the disorder, families had more positive interactions, children felt more supported by their parents, and families had better use of services. In a longer trial, children had better mood control.
What about child- and family-focused cognitive behavioral therapy?
Children with bipolar disorder struggle with mood regulation, social cognition, and working memory. These difficulties are worse after the onset of mood symptoms and make it hard to have positive interactions with peers and adults. The RAINBOW CBT program is for younger children ages 6–12 and their families. (RAINBOW is an acronym for: Routine; Affect; “I can do this”; No negative thoughts; Be a good friend [child] / Balanced life [parents]; Optimal problem solving; Ways to get support.) This therapy consists of 12 sessions lasting 60–90 minutes each. Included are psychoeducation, cognitive restructuring, self-regulation skills, positive thinking, interpersonal problem solving, and communication skills. The goals are to improve mood symptoms and psychosocial functioning. In a few open label trials and a case report, families found the treatment helpful, and manic symptoms improved.
What kind of therapy would be helpful for my teenager?
Family-focused therapy for adolescents (FFT-A) has the best support for that age group. This consists of 21 sessions over 9 months, started after recovery from a manic or depressive episode. There are three main modules: psychoeducation (medication, warning signs, mood versus personality); communication enhancement training (less punitive and negative communication style between teen and parents); and problem-solving skills (coping skills and dealing with stressful events). In two large controlled trials, FFT led to shorter recovery times, fewer depressive symptoms, and more time in remission. A second trial showed that the benefit was greatest in families with high rates of expressed emotion.
Are there other therapy options for my teen?
In smaller open label trials, cognitive behavioral therapy, interpersonal and social rhythm therapy, dialectical behavioral therapy, and motivational interviewing have all been studied. There are some initial findings in open trials of improved sleep and adherence to treatment, and decreased mood symptoms, but these therapies have not been studied enough for me to recommend them as initial options.
Therapy to educate everyone in the family about bipolar disorder, improve communication, decrease stress, and increase adherence to the treatment plan is an important part of helping your child or teenager achieve optimal control of his or her mood.
It helps to find the right “fit.” Don’t be shy about asking any therapists you meet with about their training and experience in the methods described here.
Printed as “bpKids: Psychosocial interventions for pediatric bipolar disorder,” Spring 2016
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